| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13.26 | $95.88 | $9,825.01 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |
Compounded Drug, Noc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13.26 | $95.88 | $9,825.01 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |